CHARCOT, JEAN-MARTINcareer course
decade of fame
controversies and challenges
politics and culture
CHARCOT, JEAN-MARTIN (1825–1893), French physician.
Jean-Martin Charcot was arguably the best-known physician in France during the early Third Republic. He was recognized for his brilliant accomplishments in three separate fields of clinical medicine: neurology, geriatrics, and internal medicine. He was also renowned for the circle of loyal and talented medical students he mentored and for his flamboyant stage demonstrations of pathological syndromes. Beyond his medical activities, Charcot hobnobbed with powerful politicians, strove to advance the legislative agenda of French republicanism, and gathered the elite of Parisian cultural society at his home for weekly salons.
From humble artisanal origins, Charcot rose to the apex of the French professional elite. His medical elders recognized his abilities and industry early on, and as a result his medical and academic career advanced rapidly. He received his M.D. from the University of Paris in 1853 with a dissertation on arthritis. In 1860 he was named professeur agrégé, or associate professor, in medicine. Two years later, he was appointed chef de clinique, or head of a hospital clinical service, at the Salpêtrière, a historic hospital complex on the southeastern edge of Paris, where he would spend the rest of his career. During the same period, he began to deliver weekly bedside lessons to medical students, a pedagogical genre he eventually mastered. Across the 1860s, a decade of great productivity for him, Charcot published books on infectious illnesses, geriatrics (especially gout and rheumatism), and diseases of the lungs, heart, liver, and kidneys. He also founded or cofounded numerous medical journals. In 1872 he was brought onto the Paris Medical Faculty, the most prestigious body in French academic medicine, as professor of pathological anatomy.
During the 1870s, Charcot turned with great effect to the emerging field of neurology. In traditional accounts of medical history, he is often labeled "the father of neurology." Along with John Hughlings Jackson and William Gowers in Britain and Carl Wernicke in Germany, Charcot carved the clinical specialty of neurology out of general medicine. There followed an outpouring of publications in this new field, much of it taking the distinctive form of compilations of illustrative case histories. His finest work concerned multiple sclerosis, cerebral localization and lateralization, Parkinson's disease, aphasia, locomotor ataxia (tabes dorsalis), Tourette's syndrome, and amyotrophic lateral sclerosis (Lou Gehrig's disease). In several instances, Charcot provided the initial clinical description of these classic pathological syndromes. "Charcot's joints" refers today to pain and swelling of the joints from advanced syphilitic infection, which was then rampant in European society.
Charcot achieved the height of his fame in the 1880s. For his labors, he was rewarded with the creation of the chair for the diseases of the nervous system, the first such professorial post in the world. The ministry of the interior also granted him the resources to establish a special ward for the treatment of the nervous and neurological infirmities. His voluminous publications were gathered up into a nine-volume set of collected works, and he was elected an honorary member of learned medical and scientific societies across the Western world. The wealthy, including aristocracy and royalty, sought his medical counsel.
Charcot's published medical work bears several distinctive stylistic and methodological features and was most influenced by the traditions of René Laennec and Claude Bernard. From the former physician and his followers he learned the technique of correlating bedside symptoms with postmortem tissue abnormalities. Like Bernard, the central figure in French medical positivism, Charcot believed that medical practice should integrate closely with laboratory chemistry and biology. He considered the pathology room, histology laboratory, and science lecture hall indispensable corollaries to the hospital ward. Charcot wrote in a crystalline, Cartesian style much admired by his contemporaries. He isolated a pathological syndrome by abstracting and then combining what he believed were its key symptomatological features into a kind of clinical ideal-type of the disease. By all accounts, he excelled at differential diagnosis. Many of his publications highlight Charcot the diagnostic virtuoso, discriminating precisely among the signs of complex cases that combined organic and psychogenic etiologies.
During the 1880s, Charcot took up the subject of hysteria. His work in this area attracted widespread attention, both inside and outside medicine, but ultimately it seriously compromised
his scientific reputation. Late-nineteenth-century medical practices across Europe included large numbers of patients with shifting nervous complaints that mysteriously failed to reveal any known organic cause and that resisted all manner of treatment. Often, the manifestations of these disorders imitated neurological symptoms, such as twitches, spasms, paralyses of the extremities, and difficulties of sight, speech, and gait. Charcot interpreted these baffling cases as hysteria and sought to discover their nature, course, and cure.
Most of what had previously been written about this ancient disorder Charcot dismissed as errant nonsense. According to his "scientific" model of the disease, hysteria was caused by a hereditary predisposition combined with an environmental trigger, which usually consisted of a physical accident or psychological trauma. Its underlying pathology took the form of a lesion of the central nervous system, although the exact location of this structural defect remained unknown to him. Pseudoneurological symptoms—or what he called "hysterical stigmata"—were central to its profile, and hysterical seizures consisted of certain stylized phases. Char-cot played down the possible role of sexuality in the disorder and rejected the historic notion of hysteria as "the disease of the wandering womb." Illustrating this point, a third of Charcot's published case histories of hysteria feature male patients, most of whom were drawn from the working classes. Because Charcot traced the malady to bad heredity, he believed hysterical disorders were incurable in the present state of medicine. He sought, rather, to alleviate symptoms with the application of massage, medications, hydrotherapy, and electrotherapy. Charcot advanced his clinical observations and theoretical ideas in works such as the Leçons sur les maladies du système nerveux (Lectures on diseases of the nervous system) and Leçons du mardi (Tuesday lessons), which consist of scores of case reports.
During the 1870s and 1880s, Charcot attracted medical students from throughout Europe and North America. Playing on the French term charcuterie (pork butcher's shop), observers dubbed his circle la charcoterie. An 1887 painting by André Brouillet, titled Une Leçon clinique à la Salpêtriére (A clinical lesson at the Salpêtriére school), captures the scene of Charcot as the medical master discoursing to a rapt audience of followers. Nineteenth-century France witnessed the high point of the patronal system of medical training: aspiring physicians studied with a famous figure whose work they were expected to champion uncritically and who in turn promoted their careers. The most powerful of the early Third Republic patrons, Charcot trained a generation of young French neurologists and placed them in provincial medical faculties across France. His best-known students were Joseph Babinski and Pierre Marie, who continued his work in pure clinical neurology, and Pierre Janet and Sigmund Freud, who explored the psychological aspects of the hysterical disorders. On academic leave from the University of Vienna, Freud studied with Charcot for several months in 1885–1886 and later translated into German two of the Frenchman's books. Because of Freud's subsequent fame, Charcot has often been characterized as a figure in the prehistory of psychoanalysis.
The last several years of Charcot's career, during the late 1880s and early 1890s, brought dramatic challenges to his intellectual and professional authority. His therapeutic pessimism was increasingly deemed unsatisfactory in an age when well-to-do nervous sufferers sought hope and solace. With the rise of the germ theory of disease, his degenerative hereditarian model became evermore old-fashioned. A major medical debate in late-nineteenth-century Europe centered on the nature of general paralysis of the insane, which Charcot argued was an independent pathological syndrome but which was increasingly discovered to be syphilis of the spine and brain. Some observers also asserted that Charcot was brusque and uncaring with his patients, regarding them as little more than "clinical material."
During this same period, Charcot's extravagant theories of hysteria came under attack. Critics charged that his patients had been secretly coached to perform the requisite symptoms. Similarly, the techniques of hypnosis Charcot employed in his demonstrations were discredited by sensationalistic street demonstrations. And Charcot-style hysteria appeared as a subject, image, and metaphor in plays, novels, journalism, and popular culture. (Tourists to Paris, it was said, wished to visit the Eiffel Tower, the Folies-Bergère dance hall, and Charcot's medical demonstrations!) What is more, Charcot's blatant nepotism in placing his students, and blocking the careers of others, aroused resentment; a campaign to topple "the Caesar of the medical faculty" gained momentum. Even some of his former students came to resent his stern, authoritarian manner. ("The Napoleon of the neuroses" was one of his nicknames.) Charcot's immediate posthumous years brought an eclipse of his reputation. During World War I, however, physicians returned to his medical writings on hysterical vision, mutism, amnesia, and paralysis, which seemed to presage the phenomenon of wartime shell shock and since around 1990, new editions of his writings and a major scientific biography have appeared.
An additional source of Charcot's historical interest involves his activities outside the medical field. Charcot married into the wealthy Laurent family. He and his wife maintained a lavish home in the Saint-Germain neighborhood of Paris as well as a summerhouse in the affluent western suburb of Neuilly. They invited prominent writers, thinkers, poets, scientists, scholars, and politicians to their high society dinner parties. Charcot had passionate cultural interests. He traveled widely to view museums and architecture, and he illustrated his personal letters with sketches of places and people. His artistic interests were conservative, however, and he seems not to have appreciated the revolution in French painting (i.e., impressionism and neo-impressionism) occurring around him. He read some six languages and assembled one of the largest private medical libraries in Europe, the remnants of which are still on display at the Bibliothéque Charcot on the grounds of the Salpêtriére.
Politically, Charcot was an aggressive advocate of French secular republicanism, which came to power in France during the 1880s. The journal Le Progre's Médical, which his protégé D.M. Bourneville founded in 1873, led the charge to laicize French hospitals, which mandated that medically trained nurses replace Catholic personnel. Charcot embraced the tradition of Voltairean anticlericalism. He diagnosed many past Catholic saints as hysterics, although he was not beyond sending some of his patients to the Catholic healing shrine at Lourdes. During the Franco-Prussian War of 1870–1871, when Paris was shelled heavily, Char-cot remained in the capital city to treat wounded civilians and soldiers. From that time onward, he refused to attend medical congresses in Otto von Bismarck's Germany. It was said at the time that the Franco-Russian Alliance of 1894 was brokered at the Charcot home. Charcot's son, who was married to the novelist Victor Hugo's granddaughter, became a celebrated Antarctic explorer whose ship, the Pourquoi-Pas?, was lost at sea. For such reasons, Charcot became a figure in the cultural and political, as well as medical, history of his time.
Charcot, Jean-Martin. Clinical Lectures on Diseases of the Nervous System. London, 1878. Reprint, edited with an introduction by Ruth Harris, London, 1991. A reissue of a key medical text.
——. Oeuvres complètes de J. M. Charcot. 9 vols. Edited by D.-M. Bourneville et al. Paris, 1886–1890.
——. Charcot the Clinician: The Tuesday Lessons. Translated with commentary by Christopher G. Goetz. New York, 1987. Another valuable compilation in English translation.
Freud, Sigmund. "Charcot." In The Standard Edition of the Complete Psychological Works of Sigmund Freud. 24 vols. Translated by James Strachey et al. London, 1953–1974. Vol. 3: 9–23. A discerning commentary written upon Charcot's death during the summer of 1893.
Janet, Pierre. "Jean-Martin Charcot: Son oeuvre psycho-logique." La revue philosophique 39 (June 1895): 569–604. Along with Freud's obituary, this is the most perceptive posthumous assessment.
Munthe, Axel. The Story of San Michele. Translated from the French. London, 1929. Chaps. 4, 17–19, 23. The liveliest of the literary pastiches of Charcot.
Brais, Bernard. "The Making of a Famous Nineteenth Century Neurologist: Jean-Martin Charcot (1825–1893)." M.Phil. thesis, Wellcome Institute for the History of Medicine, University College London, 1990. A brilliant—but unfortunately unpublished—account of the world of Parisian medical politics during the Charcot era.
Didi-Huberman, Georges. Invention of Hysteria: Charcot and the "Photographic Iconography of the Salpêtrière." Translated by Alisa Hartz. Cambridge, Mass., 2003. An in-depth discussion of the more sensationalistic aspects of Charcot's work on hysteria.
Goetz, Christopher G., Michel Bonduelle, and Toby Gelfand. Charcot: Constructing Neurology. New York, 1995. A thorough, authoritative, and enormously informative biography of the man and his work, with special attention to the pioneering output in neurology.
Goldstein, Jan. "Hysteria, Anti-Clerical Politics and the View beyond the Asylum." In her Console and Classify: The French Psychiatric Profession in the Nineteenth Century, 322–377. Cambridge, U.K., 1987. Despite containing numerous errors of interpretation, Goldstein's chapter is an excellent study of the anticlerical theme in Charcot's career.
Harris, Ruth. "Women, Hysteria, and Hypnotism." In her Murders and Madness: Medicine, Law, and Society in the Fin de Siècle, 155–207. Oxford, U.K., 1989. Arguably the best analysis of Charcot from a feminist perspective.
Lellouch, Alain. Jean-Martin Charcot et les origines de la geriatrie. Paris, 1992. A detailed and intelligent study of a neglected but important topic.
Micale, Mark S. "Charcot and the Idea of Hysteria in the Male: Gender, Mental Science, and Medical Diagnosis in Late Nineteenth-Century France." Medical History 34, no. 4 (1990): 363–411. A specialized study placed in medical-historical context.
——. Approaching Hysteria: Disease and Its Interpretations. Princeton, N.J., 1995. Includes scattered ideas and information about Charcot.
Mark S. Micale